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Abstract Involutional entropion is the most common type of entropion and most commonly affects the elderly, the average age is about 70 years The aetiology is thought to include varying degrees of three anatmic abnormalities: Attenuation or disinsertion of the lower eyelid retractors creating vertical instability . Attenuation of the canthal tendons creating horizontal lid laxity . Superior displacement or overriding of the preseptal orbicularis muscle over the pretrarsal space creating invward rotation of the lid margin, additionally, in cases of enophthalmos, the lack of posterior globe support may contribute to entropion formation. Although involutional entropion primarily affects the elderly it can occur whenever the supporting ligaments and tendons that stabilize the lid margin are attenuated or disinserted. Complications of involutional entropion include irritation, redness, tearing and photophobia. Untreated entropion may lead to corneal ulcer and opacification. Medical treatment of involutional entropion with lubricants, taping or orbicularis chemodenervation with botulinum toxin offer temporary correction of eye lid position and relief of the symptoms. Over 100 procedures have been described to repair involutional entropion, most of them address one or more of the three anatomic defects, the most successful procedures address all three anatomic defects and permit individual adjustment based on the relative contributions of each aetiologic factor. Surgical procedures aiming to correct the horizontal lid laxity include a modified lateral tarsal strip procedure , the Quickert procedure [Four-snip procedure] , the effective small incision surgery for repair and tarsal strip combined with modification of the Quickert-Rathbun suture technique. Also the long term effectiveness of fornix suture placement combined with a lateral tarsal strip procedure is a simple quick, physiologic and effective approach in achieving long lasting correction. Procedures effecting correction of the lower lid retractor defect by attaching the lower lid retractors to the inferior border of the tarsus as in Jones procedure, everting sutures, and reinsertion of the lower eye lid retractor aponeurosis to the tarsal plate without horizontal shortening or resection of the skin or orbicularis muscle. Lastly, procedures approaching correction of the override of the preseptal orbicularis include excising a strip of orbicularis and creating barrier to superior migration as in Wies procedure, where there is little or no horizontal lid laxity, and transconjunctival repair which include myectomy and retractor fixation. |